Dear jimbo2004-ga,
The NCQA (National Committee for Quality Assurance) offers health plan
?report cards? at <http://hprc.ncqa.org/frameset.asp>. Please note
that in Oregon Blue Cross/Blue Shield?s HMO plan is known as Regence
HMO.
These ?report cards? grade 5 measures of health plan quality: ?access
& service,? ?qualified providers,? ?staying healthy,? ?getting
better,? and ?living with illness.?
?Access & service? measures customer satisfaction based largely on
patient surveys. ?Qualified providers? rates the providers based on,
for example, lawsuits. ?Staying healthy? grades the plan?s preventive
health care services. ?Getting better? is not what it sounds like;
this measure of health plan quality rates the HMO?s inclination toward
new medical procedures, technologies, and pharmaceuticals. Finally,
?living with illness? rates the plan?s management and preventive care
for patients with chronic illnesses.
Importantly, the NCQA is not a managed-care-insider,
rubber-stamp-accreditation organization. The NCQA offers report cards
for 3 HMOs in Oregon: Kaiser Permanente, PacifiCare, and Blue
Cross/Blue Shield. All 3 health plans receive four stars -
?excellent? - for ?access & service,? ?qualified providers,? and
?staying healthy.? Blue Cross/Blue Shield?s HMO receives three stars
- ?commendable? - for ?getting better,? and ?living with illness?
while Kaiser Permanente and PacifiCare receive four stars for these
same measures of health plan quality. However, the network of
providers participating in Blue Cross/Blue Shield?s HMO is larger than
that of Kaiser Permanente or PacifiCare.
Explore the NCQA?s website for more details on how the organization
measures health plan quality and how various health plans in Oregon
rate.
I hope this helps. |
